Census Bureau Issues Working Paper Entitled 'Estimates of Health Insurance Coverage, 2013 to 2022'

WASHINGTON, Sept. 16 -- The U.S. Census Bureau issued the following working paper (No. SEHSD-WP2023-27) on Sept. 12, 2023, entitled "Estimates of Health Insurance Coverage, 2013 to 2022."

The paper was written by Rachel A. Lindstrom, Katherine Keisler-Starkey and Lisa N. Bunch.

Here are excerpts:

* * *

INTRODUCTION

The Current Population Survey Annual Social and Economic Supplement (CPS ASEC) is used to produce official estimates of income and poverty, and it serves as the most widely cited source of estimates on health insurance coverage and the uninsured. Data users look to the CPS ASEC to understand how health insurance coverage has changed over time. Over the last decade, policy changes and current events have significantly impacted health insurance coverage, complicating data users' ability to compare coverage rates across time. For example, the Patient Protection and Affordable Care Act (ACA) introduced changes in how health insurance coverage is provided, with several key provisions taking effect in 2014. As part of continuous improvement, the Census Bureau had been researching methods to collect data on new and emerging methods of coverage which culminated with a redesigned questionnaire and processing system between calendar years 2013 and 2018. Consequently, estimates from 2013 are not directly comparable with earlier years, and the launch of the improved processing system further affected how comparisons over time are made. Other issues affecting comparisons include the COVID-19 pandemic. Data collection faced extraordinary circumstances in 2020. As the United States began to grapple with the implications of the COVID-19 pandemic, the survey stopped in-person data collection to protect the health and safety of Census Bureau staff and respondents. The resulting estimates of health insurance coverage for 2019 (collected in 2020) are not directly comparable to the estimates of other years.

This paper describes the trends in health insurance coverage from 2013 to 2022 while providing guidance on how to interpret the data in the context of the changes that have occurred./3

In Section 2, the paper describes three changes related to survey methodology that affect comparisons over time. Section 3 provides an overview of changes in the health insurance landscape that may be related to changes in health insurance coverage estimates produced using the CPS ASEC. Section 4 presents estimates of the percentage uninsured, the percentage with private coverage, and the percentage with public coverage from 2013 to 2022. Finally, Section 5 summarizes the findings.

* * *

SUMMARY

Comparing estimates of health insurance coverage from the CPS ASEC across time can be complex due to questionnaire redesign, policy changes, and current events that have occurred over the last decade. Estimates from 2013 are not directly comparable with earlier years due to a questionnaire redesign in 2014. An improved system for processing data, officially launched for calendar year 2018, requires consideration when comparing data across the last decade. Data users should also exercise caution when making comparisons with calendar year 2019 estimates as the COVID-19 pandemic affected data collection in 2020. Finally, population controls based on the decennial census have also changed in the last several years; estimates up until 2019 use 2010 Census-based population controls, while estimates in 2020 and later years use 2020 Census-based population controls.

Given these complexities, this paper discusses appropriate comparisons of health insurance coverage rates over time. Data show that the uninsured rate declined over time. The rate of private coverage increased with the implementation of the ACA, leveled off, and then decreased over the COVID-19 pandemic, and rates of public coverage and Medicaid coverage also experienced both increases and decreases over the 2013 to 2022 time period.

* * *

The paper is posted at: https://www.census.gov/content/dam/Census/library/working-papers/2023/demo/sehsd-wp-2023-27.pdf